Tag Archives: Dermatology

During the last presentation on the last day of the Summit in Aesthetic Medicine 2012, Dr. R. Rox Anderson shared some of his observations on creating change in the world of medicine. As the person who conceived of or helped develop many of the non-invasive treatments now widely used to remove birthmarks; microvascular and pigmented lesions; tattoos; and hair, he should know a thing or two about that topic.

“It takes people with passion,” Dr. Anderson, professor of dermatology at Harvard Medical School, Boston, said of change-leaders in medicine. “We’re driven to help other people. That is my primary passion. I go to work every-day thinking, ‘Science for the people.’ It’s also important to get very specific about the problem. I’ve noticed that the ability to really define the problem and own it is often where some of the passion comes from. Working on something that someone else told you about often does not sustain the process that you have to go through to make substantial change.”

Dr. Rox Anderson

Medical change-leaders exhibit unbridled curiosity mixed with health skepticism. “It’s interesting how change can happen if you mix people who are very problem-oriented with people who are very technology-oriented,” said Dr. Anderson, who also directs the Wellman Center for Photomedicine. “I kind of walk around with two bags: One of them you might label ‘Problems I care about but don’t know how to solve,’ the other one ‘Stuff I know about technology-wise.’ The challenge is to connect the two. I don’t know how that happens, but when it happens right, you get change.”

Change-leaders tend to be resilient, he said, explaining that real change is usually either threatening or surprising. “There’s a phrase, ‘You can tell the pioneers by the arrows in their backs.’ People are very uncomfortable with change. You will find that if you’re trying to put something new out there, you may threaten someone’s paradigm.”

In the business of medicine, he continued, “the bottom line is helping others. In medicine, if the problem isn’t about helping people, it’s going to fail. If you’re not curious and skeptical about something important, you’ll be off on some tangent that won’t ultimately make a tangible change.”

Strong commitment to the problem you’re trying to solve is essential, he said. He likened the level of commitment to a marriage in which you “Write a grant and start making phone calls to your colleagues, get a collaborative group together and say, ‘We’re going to attack this problem.’ Then you and the problem have ‘children’ – 3 or 4 ideas [of how to] solve the problem. Some of them work, some of them don’t. It’s the ones that don’t work that teach you things. My definition for bad research is that you can predict the outcome.

The Food and Drug Administration is paying attention to the little things—the very little things. The FDA recently released guidelines for industry on the use of nanotechnology in food and cosmetics. The draft guidelines have been issued for public comment, according to the FDA website.

Courtesy Wikimedia Commons/KoS/Creative Commons License

The Nanodermatology Society issued a statement in response to the guidance for nanotechnology use in cosmetics—an issue that will continue to interest dermatologists as the technology evolves. The NDS stated its belief that the FDA has a responsibility to ensure the evaluation of nanomaterial use in cosmetics, including both over-the-counter and prescription products.

The guidelines must measure up to the science, however. “The NDS believes that the guidelines should not be based on controversial evidence, weak evidence, or pure conjecture,” according to the NDS statement. To that end, the NDS pointed out a few areas of the guidelines where scientific evidence could be more complete. For example, with respect to titanium dioxide, the NDS notes that “TiO2 can accumulate in tissues such as kidneys, but can also be eliminated, for example, in the liver in some animal models.” In addition, the NDS notes that a guideline proposing that penetration studies should be conducted on both intact and impaired skin might not be appropriate in cases where products are recommended for use on intact skin only.

In addition, the NDS recommended an expiration period for the final guidelines, due to the swift evolution of nanotechnology.

A 22-year-old model with a distinct tattoo is murdered in Miami Beach. A dermatologist learns of the mysterious case while taking a skin cancer biopsy from a friend, a red-headed, fair-skinned policeman. “Doc, you know a lot about tattoos, don’t you?”

So starts “The Skinvestigator: Tramp Stamp,” the first in the Sunshine State Trilogy series of hard-boiled detective fiction written by Florida dermatologist Dr. Terry Cronin, Jr.

“It takes a lot of the knowledge I have about tattoos and feeds it into the mystery,” Dr. Cronin said in an interview. “But it also talks a lot about ‘scalpel tourism,’ where people go to foreign nations to get plastic surgery and cosmetic surgery at cut-rate prices, and a lot of times they get mutilated. That plays a big part in the murder mystery.”

Dr. Terry Cronin, Jr. (photo by D. McNamara)

Miami dermatologist Dr. Harry Poe delivers some important messages in the book as well. “He’s out there trying to promote prevention of skin cancer.” Like most dermatologists, he faces the challenge of warning people about the dangers of sun exposure in a culture that values tanning and looks above safety. When Dr. Poe goes to the beach, for example, everyone is lying out in the sun while he’s wearing long sleeves, a hat, sunglasses, and sunscreen. “And people make fun of him,” Dr. Cronin said.

A dermatologist as detective makes sense – because they use the same type of skills to diagnose skin conditions in their patients every day, explained Dr. Cronin, who is in private practice in Melbourne, Florida.

“I’ve always had a creative flair. I was involved in film making ‑ short films, going to independent film festivals. I ended up writing for comic books. Then I got the idea that I really wanted to tell a story that was pro-dermatologists.” Although Dr. Cronin had always kept his professional and creative sides separate, that was about to change.

The first book in the Sunshine State Trilogy (photo by D. McNamara)

“I wanted to tell a story in which the dermatologist was the hero. I love mysteries, like the Travis McGee series from John D. MacDonald and books byEd McBain and Ken Bruen. I thought ‘maybe I can make this hard-boiled dermatologist detective story, in which the dermatologist is pulled into an investigation. By using his expertise in diseases of the skin, he is able to help police solve a murder.”

Even though Dr. Cronin went through a “big process” of writing draft after draft, honing the story through multiple editors (including Michael Garrett, an editor for Stephen King), and encountering some challenges along the way, he encourages other physicians to pursue their outside passions as well.

“If a physician wants to be a writer, they should let their creative juices flow and do it. Don’t take ‘no’ for an answer,” Dr. Cronin said. “All doctors are pretty smart people, pretty motivated people, who have lots of talents. Some have those talents, but they tamp them down because of their professional needs. I think you have to have an outlet.”

Dr. Cronin initially self-published and sold copies of “Tramp Stamp” at Comic-Conand through Amazon.com. Then a friend at Barnes & Noble encouraged him to sell the bookstore management on ‘The Skinvestigator” series. They liked it and helped him find a publisher. (The store does not inventory self-published titles.) “Now it’s on the shelf in Barnes & Noble. That’s a thrill.”

Dermatologist colleagues have been very supportive, Dr. Cronin said. “That’s the thing I like the most. A lot of dermatologists have been reading it and giving me feedback that is good. I appreciate that.”

“The lay person will enjoy the book, but a dermatologist will get a kick out of it. They know the language and they will laugh because so much of it is authentic.”

The second book in the series “The Skinvestigator: Rash Guard” is about surfers, syphilis, and the state department. The third installment, yet to be published, will be called “The Skinvestigator: Sun Burn.”

The Federal Trade Commission (FTC) says no, definitely not. On Sept. 8, the agency announced that it had reached settlements with two companies that were claiming that their apps could cure acne. It is the first time the FTC has pursued any company making a health claim for an app.

“AcneApp” and “Acne Pwner” both claimed to be able to treat acne with colored lights that come out of the phone when the app is activated. Purchasers were told to hold the screen next to the affected area of skin for few minutes daily.

The agency was having none of it. “Smartphones make our lives easier in countless ways, but unfortunately when it comes to curing acne, there’s no app for that,” said FTC Chairman Jon Leibowitz, in a statement.

Acne Clear app. Photo by Alicia Ault

According to the FTC, there were 3,300 downloads of AcnePwner, for sale in the Android Marketplace for 99 cents. AcneApp was downloaded 11,600 times from the iTunes store at a cost of $1.99 each.

The AcneApp makers claimed that the app was developed by a dermatologist and that its technology was backed up by a study in the British Journal of Dermatology. Nope, not true, said the FTC.

The settlements bar the app makers from making acne-treatment claims and they were ordered to pay nominal fines. Koby Brown and Gregory W. Pearson, doing business as DermApps, have to pay $14,294, and Andrew N. Finkle, doing business as Acne Pwner, was ordered to pay $1,700.

The trade journal mobihealthnews reported that both apps had been removed from retail earlier this year or late last year. Mobihealthnews also noted that the New York Times gave the AcneApp some press in late 2009. Gregory Pearson is identified in that story as a Houston-area dermatologist.

Apps that claim to offer curative powers were the subject of a two-day workshop that the Food and Drug Administration just wrapped up. The agency has been mulling over how and when to regulate mobile apps. It looks like the FTC may have beaten it to the punch.

But there are likely to be plenty more apps to scrutinize in the future.

A quick check of the Android marketplace today from my smartphone found, “Acne Clear,” from United Holdings Group, being sold at 99 cents. It supposedly “uses a specific sound frequency and a blue color wavelength from the Lapis Lazuli gemstone to help clear and detox the skin.” United also markets a “Skin Cleanser” app that supposedly uses a sound frequency and “a yellow color wavelength from the Imperial Topaz gemstone to help clean the skin of dark spots, sun spots, and acne scars.” It’s 99 cents.

There’s also “SkinApp” from M&R Selected, which is free. and advises that it allows you to do “color light therapy on the go.” It is listed as having 10,000 to 50,000 downloads. The reviews are full of testimonials that it works, but also that it is just plain “bad.”

What kind of review would you give these apps? Should patients download them, or are they better off keeping their 99 cents?

In Tanzania, where some of the oldest human fossils have been found, and where Mt. Kilimanjaro rises above the clouds, a group of international dermatologists are hoping to help a very vulnerable population.

The region has one of the highest incidences of albinism in the world. Although the condition is rare in the western world, it is quite common in sub-Saharan Africa, according to some studies. (While the incidence of this genetic condition is about 1 in 37,000 U.S. residents, the rate in this region is as high as 1 in 1,400.)

The people with albinism are also subject to discrimination, stigma and even murder.

Sun Damage to Back of an Albino Individual

But, another important concern is the health of the albinos whose pink skin is exposed to the African sunshine, and where many of the occupations are outdoors and in the field.

Many of the locals with albinism die of cancer before age 40; in fact, fewer than 2% make it to their 40th birthday. And almost all of the children with albinism show signs of sun damage before age 10.

Because of a lack of funding, many can’t afford hats to protect themselves; because of a lack of education, many don’t know the link between sun damage and cancer.

Called “Hats On for Skin Health,” a collaboration between the ILDS and Stiefel, the project is a global effort to raise funds for the purchase of hats and other protective items for albinos in Tanzania.

Sun-Protective Hat on an Albino Girl

The items will be distributed by RDTC that manages a mobile skin care clinic, which regularly visits people with albinism living in the region and educates the locals, especially parents, about albinism. The lesson they try to get across, said Dr. McLean, is to let their children play outdoors, but cover them up first.

The group has located a hat manufacturer in Moshi, which is currently producing template models for children and adults. Many of the workers, said Dr. McLean, have albinism. “We think that’s definitely part of the solution going forward,” he said.

The cost of manufacturing a hat in Africa? Less than $2.50. The hats are expected to last for at least for 10 years.
To start the campaign, Stiefel, a subsidiary of GlaxoSmithKline, has donated $25,000, and Dr. McLean hopes that dermatologists, other professionals, and even the public, get involved with the campaign.

“Our people are on the ground there. We know what happens to every donated dollar,” said Dr. McLean.

Let’s face it — proctology aside — there’s probably no medical specialty that gets less respect than dermatology. Say the word “dermatology” to the average person on the street and you’ll hear about Botox, peels, fillers and treating some kid’s acne — and how every rash is dermatitis and it just needs some cream — and how most derms finish up their patient schedules in time to get out on the links. Dermatology is, in some ways, the Rodney Dangerfield of medicine.

It was fascinating to hear how a dermatologist would notice one small mark or odd skin pattern and make the jump to consider that he or she might not be looking at a single skin condition but one with elements of different conditions. At the same time, they’re trouble-shooting treatment — adding and subtracting drugs to relieve different symptoms and comfort the patient.

I think it’s high time to put this old stereotype to bed. Dermatologists are among some of the hardest-working people in the business. So, can we give ’em a little respect; they’ve earned it.